2. 25MARKETING HEALTH SERVICES
FALL /WINTER 2013 25MARKETING HEALTH SERVICES
In 2009, the national debate
about health care in America
was heating up. Armed
with an earful from worried
and frustrated constituents,
politicians were again getting ready to
tackle reforming the country’s health care
system. As finger-pointing began, health
insurance companies—always a popular
target—often were characterized as the
villains chiefly responsible for rising
costs and a host of other issues. As the
battle escalated, insurers like Blue Cross
Blue Shield of North Dakota (BCBSND)
found themselves caught in the middle.
National news coverage focused on the
more interesting stories about industry
profits, pay, perks and employee junkets
rather than stories on the impact of
utilization rates or shared responsibility
for rising medical costs.
In North Dakota, sensational local
stories added fuel to the fire, further
tarnishing BCBSND’s image. After a year
of negative headlines about the company,
along with political angst about reform
and the insurance industry, its brand
reputation was at an all time low. North
Dakotans were blaming BCBSND for ris-
ing costs and losing trust in the venerable
not-for-profit mutual company. Despite
negative publicity, independent research
conducted by the health plan in 2010
revealed that members were looking to
BCBSND to step up and find the needed
solutions, so the organization decided
it was time to set the record straight,
reassure its members and regain their
confidence. In a changing health care
landscape, it was time for a dramatic shift
in the way BCBSND did business.
Bolder Shades
Initial research revealed surprising in-
sights in the midst of the controversy:
North Dakotans, including BCBSND
members, were tired of politics and
finger pointing. They were looking for
advocacy and solutions to their prob-
lems. Driven by these findings—and in
support of an aggressive new business
plan that included launching a collabo-
rative, statewide sustainable health initia-
tive to save $30 million in its first three
years and $15 million later—BCBSND’s
internal communications team partnered
with Fargo, N.D.-based marketing and
communications network Flint Group
to develop a comprehensive, multi-year
communications plan to repair the brand
and engage employees and members.
The Bolder Shade of Blue campaign
was built on a consumer promise to
“Work with You and for You.” It show-
cased BCBSND’s efforts to take matters
into its own hands, push boundaries
and instigate new ideas while staying
true to its founding principle to provide
affordable, high-quality health care.
Members and provider partners were
the inspiration for BCBSND’s BOLD
initiatives, and the campaign highlight-
ed their stories to demonstrate the im-
pact on real people.
BCBSND employees also appeared
to be losing faith in the brand and
were unsure where the company was
headed. That prompted internal initia-
tives aimed at consistent messaging,
two-way dialogues, instilling pride and
engaging employees as brand ambas-
sadors and bold committee members.
Employees had their own bold stories
to tell, which were featured on lively
“Bolder Shade of You” posters. Recruit-
ment pieces asked new and prospective
employees “Just how BOLD are you?”
and challenged them to help shake up
the industry.
Listen Before
You Educate
Designed to be member-driven,
straightforward and focused on finding
bold solutions to rising costs, the ex-
ternal strategy included three phases:
listening, educating and demonstrating
the company’s impact on members and
communities across the state.
THE ART of using consumer-driven strategies to
help combat negative customer perceptions, restore
brand trust and revitalize relationships transforms
how one insurance company does business
3. The listening phase was about hearing
what North Dakotans had to say about
health care. It began with a statewide
survey of BCBSND members that
generated an 8% response rate, nearly
13,000 returns, and plenty of insight
about what was on people’s minds. This
information helped shape the campaign
direction. The discussion moved across
the state in a series of well-publicized
community forums where North
Dakotans were invited to share their
ideas, concerns and questions. People
could participate in person or online,
where the conversation continues today.
Forums were streamed live and available
for playback. Online panels of 3,500
members and employers, representing a
good cross-section of BCBSND market
segments, were recruited to provide
ongoing customer feedback on topics
ranging from product advertising to
benefits explanations to website usability.
The education phase was driven by
the issues raised during the listening
phase. A series of eight advertorials
provided answers to frequent questions,
such as “Why does my health insurance
cost so much?” or “How will health
reform impact North Dakota?” When
it became obvious that members didn’t
understand how their premiums were
being spent, that became the first ad-
vertorial topic. The advertorials drove
readers to the Blue Insight blog to learn
more. After each advertorial, blog traffic
increased and readers spent longer time
than average engaged in the site. Rich
media ads allowed for high visibility and
a high interaction rate. Media outreach
and other brand awareness collateral—
including presentations, annual reports
and brochures—also helped support the
BOLD campaign goals to educate,
engage and demonstrate leadership.
Real People,
Real Stories
North Dakotans wanted proof that
BCBSND was doing what it professed,
so the third phase of the strategy focused
on showcasing members who told their
own compelling stories. TV and print
ads demonstrated how BOLD BCBSND
initiatives were inspired by a variety of
members.
BCBSND’s proactive social strategy
facilitated ongoing online conversations
about its bold initiatives and provided
constituents with a credible destination
for engaging in those conversations. Criti-
cal conversations with the right people are
taking place every day. To date, BCBSND
has reached nearly 200,000 Facebook
and 8,000 Twitter users—mostly North
Dakotans. Health care business informa-
tion publisher MCOL named a BCBSND
employee who tweets on behalf of the
company as one of 10 health plan com-
munications and marketing professionals
to follow on Twitter.
Healthy
Initiatives
Providing members with tools and re-
sources to help them live their healthiest
lives was an important campaign strategy
in support of BCBSND’s major initiative
to reduce the cost of health care. Initia-
tives included:
• Launching a Healthy Blue Online
Wellness Center.
• Working with North Dakota’s lieutenant
governor and public employee retire-
ment system to create “Daily Doses of
Wellness” webinars for the state’s largest
employee base.
• Monthly worksite wellness print materi-
als for North Dakota workplaces.
• Becoming “The Official Sponsor
of Recess,” a wellness initiative
promoting daily activity for North
Dakotans of all ages. To date, 7,000
recess kits have been distributed to
teachers.
• Sponsorships of a new look for an
indoor playground at the state’s larg-
est shopping mall, and a statewide
program for organizations and com-
munities awarding grants for healthy
activity programs developed with local
health providers.
Positive publicity and great cre-
ative can easily be undone if members
have one negative online experience.
BCBSND’s digital strategy made it easy,
useful and enjoyable for consumers,
members, employers, providers and
agents to find what they needed to
do business with the company. New
tools included an extensive redesign of
BCBSND members’ and Blue Connect
websites, electronic explanations of
benefits (eEOBs) and a mobile site.
As expected, research revealed that
affordability is a primary issue for mem-
bers and employers, and there was a
perception that BCBSND didn’t offer
enough options. BCBSND’s product
campaign helped repair the brand by
demonstrating to members that it has
affordable product choices. Its direct re-
sponse approach included print, online,
flash and rich media, and TV and radio
ads promoting new products.
Total sales in 2012 increased almost
66% from 2011, and that number
continues to trend upward. In 2013,
26 MARKETING HEALTH SERVICES
FALL /WINTER 2013
1,2,3, REPEAT
BCBSND’s brand perception has improved dramatically—from a 76% negative
image perception in 2011 to a 52% positive image in 2013, according to a Street
Smart brand tracking study.
4. 27MARKETING HEALTH SERVICES
FALL /WINTER 2013
BCBSND enrolled a record
number of 500,000 members.
In recent years, BCBSND has
dramatically shifted its media
philosophy, moving from a
desire to stay out of the news
to taking a more proactive
approach—telling its story by
positioning the company as
a thought leader, serving as a
voice for members and framing
its messages from a member
perspective. As a result, news
coverage shifted from 76% neg-
ative coverage in 2009 to 76%
positive news coverage in 2012.
Year-to-date coverage and men-
tions in 2013 have been 90%
positive, 8% neutral and
2% negative.
Exceeding
Expectations
As part of the 2013 BCBSND
Brand Image Tracking Study con-
ducted by StreetSmart Research,
business and consumer reactions
to the current Bolder Shade of Blue
Member Advocacy advertising
campaign became available.
The vast majority of participants
indicated that they viewed the
Bolder Shade of Blue Member
Advocacy campaign as credible,
relevant and compelling. They
related to the real stories, and the per-
sonal approach made them feel good
about BCBSND as a company. One
participant stated, “BCBSND really
cares about people and [the ads] kind
of takeaway their corporate image
and come down to an individual lev-
el.” The “Work with You and for You”
messaging and BOLD strategies have
increased trust and given members
the impression that BCBSND is there
to help. As a point of reference, in the
2011 brand image tracking study, con-
sumers had a 76% negative image asso-
ciation of BCBSND. In the 2013 brand
image tracking study, however, con-
sumers had a 52% positive image asso-
ciation of BCBSND. In 2011, BCBSND
was seen as the primary cause for rising
costs. But in 2013, health care was seen
as the primary cause of cost increases.
Staying the Course
The hard-hitting, fact-based Bolder
Shade of Blue campaign moved the
company off the sidelines and demon-
strated that it was the tried-and-true
BCBSND—the same one that mem-
bers’ parents had relied on and one
that they could trust in for the future.
The cumulative results of all of these
initiatives combined with market-
ing communications are correcting
misconceptions as well as improving
BCBSND’s brand image and relation-
ships with customers.
Internal customer service,
sales and support initiatives
also are impacting brand per-
ceptions. Customer service
impressions have improved
dramatically with both busi-
nesses and consumers. Em-
ployer workshops, meetings
and customer support have
improved brand perceptions.
Proactive and transparent
communication strategy is
correcting dated—and what
the company perceives as un-
fair—image perceptions with
the general public and media.
Increasingly, according to in-
dependent research, business
and consumers believe the
company has been open and
honest and appears to gen-
uinely care about improving
costs and access and satisfy-
ing customers. From 2012
to 2013, BCBSND scored
higher in:
• Customer satisfaction
(from 62% to 73% among
consumers; 59% to 77%
among employers).
• Likelihood to renew
(from 66% to 70% among
consumers; 69% to 70%
among employers).
While there is still work to do, the
strategy is working—the brand is
stronger today than in 2009, and the
company is better positioned to navi-
gate the tidal wave of change sweeping
across the health care industry. MHS
✒ DENISE KOLPACK is chief of staff and
senior vice president of communications and
public affairs at Blue Cross Blue Shield of North
Dakota, a health insurance company with 500,000
members in a state with a population of 700,000.
KIMBERLY WOLD JANKE is vice president
of account planning and brand strategy at Flint
Group, a network of marketing and communication
agencies. Both are based in Fargo, N.D. They can
be reached at denise.kolpack@bcbsnd.com and
kimberly.janke@flintcom.com, respectively.
KEY LEARNINGS: Following up on what the company
learned in the listening phase, CEO Paul von Ebers and
others from BCBSND toured the state, hosting face-to-
face community health care forums and opening up an
ongoing dialogue with North Dakotans that continues
online today.
